Thursday, August 28, 2008

Report changes for Kaiser of Georgia

For those clients that bill to CPID# 1845 and/or 8546 Kaiser of Georgia through RelayHealth please be advised that starting immediately on August 28th 2008 Kaiser of Georgia will be returning to the 277 unsolicited report. Providers will no longer receive the Kaiser of Georgia Status Report.

Please familiarize yourselves with the new report and be aware that you will no longer be receiving the Kaiser of Georgia Status Report.

Confused by
Electronic Medical Claim billing then read these articles on Billing Health Insurance medical claims

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New Jersey Medicare converting to Highmark Medicare Services

New Jersey Medicare electronic claims through RelayHealth will stop going to Riverbend and will be transmitted to Highmark Medicare Services on September 2nd 2008.


  • Riverbend will receive their last claim file on August 28th 2008.
  • All claims sent to RelayHealth from August 30th - September 2nd are observed as Dark Days which means that in a work week (Monday - Friday) claims will not be transmitted to Medicare.
  • September 2nd 2008 Claims will be routed to Highmark Medicare Services
  • September 3rd 2008 Highmark Medicare Services will begin their first payment cycle
EDI Agreement are required but providers already transmitting with EDI agreements do not need to complete a new agreement. If you are already setup with Electronic Remittance Advice (ERA) you do not need to complete another EDI Agreement.

CPID# will remain 5503

Please be aware of the claims processing dates and the down days as this will delay your insurance payments.

Learn more about Electronic
Medical Billing and Coding at this site medical billings and health insurance claims


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HHS released NPRM for Electronic Transaction Standards X12

On Friday, August 22, 2008, in the Federal Register the Department of Health and Human Services (HHS) released the Notice of Proposed Rule Making (NPRM) for Electronic Transaction Standards X12 5010, NCPDP D.0 and NCPDP 3.0, and the Medical Data Code Set Standards ICD-10.

The current versions of the NPRMs are at the following web address:

Implementation and ongoing usage of the 4010A1 HIPAA standards have allowed the industry to identify many areas needing improvement, including the ability to support ICD10. The new 5010 transaction standards provide resolutions for many of the issues uncovered with 4010A1, in addition to providing the ability to support ICD10. Under the proposed rule, compliance with ASC X12 version 005010 would be required by April 1, 2010.

The HIPAA Standard Transaction Sets included in the NPRM are:
270/271: Health Care Eligibility Benefit Inquiry and Response
276/277: Health Care Claim Status Request and Response
278/278: Services Review Request for Review/Response
820: Payroll Deducted and Other Premium Payment
834: Benefit Enrollment and Maintenance
835: Health Care Claim Payment/Advice
837P: Health Care Claim: Professional
837I: Health Care Claim: Institutional
837D: Health Care Claim: Dental

The public comment period is from August 22, 2008 through 5:00 PM Central on October 21, 2008. This period is open for anyone to submit comments, using the documentation provided in the links above.

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Legacy Identifier for Blue Medicare PPO

If you received a rejection/exclusion from RelayHealth for CPID# 4484 Blue Care PPO please resubmit these claims.

Edit: The Legacy identifier, Employers Identification Number, May not be used for this payer after the National Provider ID (NPI) is Mandated for use.

RelayHealth has made changes to their software to send only the NPI information which will naturally correct this issue for all future claims.

For more articles about
Medical Billing and Coding read this Over 250 Medical Billing and Coding Articles

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Gateway Health Plans through RelayHealth

RelayHealth has direct connection with Medicare Assured and Medicaid Ohio for Institutional Claims (UB-04) as of August 27th 2008. To take advantage of sending electronic claims through RelayHealth please begin using CPID#2912 for Medicare Assured - Gateway Health Plan for Institutional Claims and Remittance and CPID#3972 for Medicaid Ohio Gateway Health Plan - Institutional Claims.

** Payor Agreements are not required to submit claims electronically to meaning you can send claims now.
** 277U and RelayHealth standardized Payor Reports will follow after claim submission

Payor Speicifc Edits have been added also:
CPID#2912 for Medicare Assured - Gateway Health Plan for Institutional ClaimsEdit 01 0091C:INVALID SUBSCRIBER ID - IN LOOP 2010BA, NM109 MUST BE EITHER 8, 10, 11 OR 12 ALPHANUMERICS.

Edit 21 0023C:MISSING REND PROV NAME/NUMBER - LOOP 2310B MUST BE SENT

Edit 21 0453C:MISSING RENDERING PROV NBR - IN LOOP 2310B, IF NM108 IS NOT XX, THEN THERE MUST BE A REF01=G2

Edit 52 0071C:MISSING RENDERING PROVIDER NBR - IN LOOP 2310A, IF NM108 IS NOT XX, THEN THERE MUST BE A REF01=G2.

CPID#3972 for Medicaid Ohio Gateway Health Plan - Institutional ClaimsEdit 01 0089C:INVALID SUBSCRIBER ID - IN LOOP 2010BA, NM109 MUST BE EITHER 8 OR 12 NUMERICS.

Edit 52 0071C:MISSING RENDERING PROVIDER NBR - IN LOOP 2310A, IF NM108 IS NOT XX, THEN THERE MUST BE A REF01=G2.

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Wednesday, August 27, 2008

Insurance Carrier for medical claim submission

I have listed some common medical claim insurance carrier billing list for doctors the format is RelayHealth's CPID#, Insurance carrier name, City, State, 9 digit zip code and phone number as we show being current at this time.

CPID# 4300
29 PALMS BAND OF INDIAN H
3707 5TH AVE
609
SAN DIEGO, CA 92103-4221

CPID#4300
AAG AMERICAN ADMINISTRATI
PO BOX 612989
DALLAS, TX 75261-2989

CPID#4300
AARP CLAIM UNIT
PO BOX BOX 740819
ATLANTA, GA 30374-0819
(800) 523-5800

CPID#4300
AMERICAN PIONEER LIFE
PO BOX 130
PENSACOLA, FL 32591-0130
(800) 999-2224

CPID#6436
AMERICAN POSTAL WORKERS
PO BOX 10398
SCOTTSDALE, AZ 85271-0398
(800) 222-2798

CPID# 6467
GOVERNMENT EMPLOYEES HOSP
PO BOX 4665
INDEPENDENCE, MO 64051-4665
(800) 821-6136

CPID#6408
GREAT WEST
1000 GREAT W DR
KENNETT, MO 63857-3749
(800) 445-2158

CPID#6408
GREAT WEST
PO BOX 5011
FORT SCOTT, KS 66701-7111
(800) 685-3040

CPID#6436
AMERICAN POSTAL WORKERS U
PO BOX 3279
SILVER SPRING, MD 20918-3279
(800) 222-2798

CPID# 6408
GREAT WEST LIFE AND ANNUI
719 TEACO RD
KENNETT, MO 63857-3741
(888) 377-9378

CPID#6436
AMERICAN POSTAL WORKERS U
PO BOX 1358
GLEN BURNIE, MD 21060-1358
(800) 222-2798

CPID#2895
AMERICAN REPUBLIC INC
PO BOX 10
DES MOINES, IA 50306-0010
(800) 641-0366

CPID#1710
AMERIHEALTH MERCY
PO BOX 7118
LONDON, KY 40742-7118
(800) 521-6007

CPID#2497
ANGELES IPA
711 W COLLEGE ST
688
LOS ANGELES, CA 90012-1163

CPID#4300
ANTHEM HEALTH
PO BOX 873
SACRAMENTO, CA 95812-0873
(800) 888-1801

CPID#4300
APOLLO INSURANCE
4704 W JENNIFER
104
FRESNO, CA 93722-6419

CPID#8456
ARCADIAN MANAGEMENT SERVI
PO BOX 4198
COVINA, CA 91723-0598
(800) 699-5125

CPID#8456
ARCADIAN MANAGEMENT SERVI
PO BOX 4218
COVINA, CA 91723-0618
(866) 424-4748

CPID#4300
ASSOC HISPANIC PHYSICIANS
880 S ATLANTIC BL
201
MONTEREY PARK, CA 91754-4773

CPID#4300
ASSOCIATED STUDENTS INC
PO BOX 24768
LOS ANGELES, CA 90024-0768

CPID#4300
AT&T COMMUNICATION WC
333 S BEAUDRY ST
12TH FL
LOS ANGELES, CA 90017-146

CPID#1732
ATHENS ADMINISTRATORS AHC
2552 STANWELL ST
PO BOX 696
94520-4851

CPID#4300
AVMA GROUP HEALTH
PO BOX 909720
CHICAGO, IL 60690-9720
(800) 621-6360

CPID#4300
ANTELOPE VALLEY MEDICAL G
44469 N 10TH ST W
LANCASTER, CA 93534-3324
(661) 723-2864

CPID#4300
AXMINSTER MEDICAL GROUP
11539 S HAWTHORNE BL
6 FLOOR
HAWTHORNE, CA 90250-2381

CPID#4300
BANKERS FIDELITY CLAIMS
PO BOX 105652
ATLANTA, GA 30348-5652

CPID#4300
BANKERS LIFE AND CASUALTY
PO BOX 66927
CHICAGO, IL 60666-0927
(312) 777-7000

CPID#4300
GREATER COVINA MED GROUP
605 E BADILLO ST
STE 300
COVINA, CA 91723-2847

CPID#4300
GREATER NEWPORT IPA
PO BOX 6270
NEWPORT BEACH, CA 92658-6270

CPID#4300
GREATER SAN GABRIEL VALLE
1680 SOUTH GARFIELD AVE
ALHAMBRA, CA 91801-5413
(626) 282-0288

CPID#4300
AAG AMERICAN ADMINISTRATI
PO BOX 612989
DALLAS, TX 75261-2989

CPID#4300
AARP CLAIM UNIT
PO BOX BOX 740819
ATLANTA, GA 30374-0819
(800) 523-5800

CPID#4300
AMERICAN PIONEER LIFE
PO BOX 130
PENSACOLA, FL 32591-0130
(800) 999-2224

CPID#6436
AMERICAN POSTAL WORKERS
PO BOX 10398
SCOTTSDALE, AZ 85271-0398
(800) 222-2798

CPID#6467
GOVERNMENT EMPLOYEES HOSP
PO BOX 4665
INDEPENDENCE, MO 64051-4665
(800) 821-6136

CPID#6408
GREAT WEST
1000 GREAT W DR
KENNETT, MO 63857-3749
(800) 445-2158

CPID#6408
GREAT WEST
PO BOX 5011
FORT SCOTT, KS 66701-7111
(800) 685-3040

CPID#6436
AMERICAN POSTAL WORKERS U
PO BOX 3279
SILVER SPRING, MD 20918-3279
(800) 222-2798

CPID#6408
GREAT WEST LIFE AND ANNUI
719 TEACO RD
KENNETT, MO 63857-3741
(888) 377-9378

CPID#6436
AMERICAN POSTAL WORKERS U
PO BOX 1358
GLEN BURNIE, MD 21060-1358
(800) 222-2798

CPID#2895
AMERICAN REPUBLIC INC
PO BOX 10
DES MOINES, IA 50306-0010
(800) 641-0366

CPID#1710
AMERIHEALTH MERCY
PO BOX 7118
LONDON, KY 40742-7118
(800) 521-6007

CPID#2497
ANGELES IPA
711 W COLLEGE ST
688
LOS ANGELES, CA 90012-1163

CPID#4300
ANTHEM HEALTH
PO BOX 873
SACRAMENTO, CA 95812-0873
(800) 888-1801

CPID#4300
APOLLO INSURANCE
4704 W JENNIFER
104
FRESNO, CA 93722-6419

CPID#8456
ARCADIAN MANAGEMENT SERVI
PO BOX 4198
COVINA, CA 91723-0598
(800) 699-5125

CPID#8456
ARCADIAN MANAGEMENT SERVI
PO BOX 4218
COVINA, CA 91723-0618
(866) 424-4748

CPID#4300
ASSOC HISPANIC PHYSICIANS
880 S ATLANTIC BL
201
MONTEREY PARK, CA 91754-4773

CPID#4300
ASSOCIATED STUDENTS INC
PO BOX 24768
LOS ANGELES, CA 90024-0768

CPID#4300
AT&T COMMUNICATION WC
333 S BEAUDRY ST
12TH FL
LOS ANGELES, CA 90017-1466

CPID#1732
ATHENS ADMINISTRATORS AHC
2552 STANWELL ST
PO BOX 696
Concord CA 94520-4851

CPID#4300
AVMA GROUP HEALTH
PO BOX 909720
CHICAGO, IL 60690-9720
(800) 621-6360

CPID#4300
ANTELOPE VALLEY MEDICAL G
44469 N 10TH ST W
LANCASTER, CA 93534-3324
(661) 723-2864

CPID#4300
AXMINSTER MEDICAL GROUP
11539 S HAWTHORNE BL
6 FLOOR
HAWTHORNE, CA 90250-2381

CPID#4300
BANKERS FIDELITY CLAIMS
PO BOX 105652
ATLANTA, GA 30348-5652

CPID#4300
BANKERS LIFE AND CASUALTY
PO BOX 66927
CHICAGO, IL 60666-0927
(312) 777-7000

CPID#4300
GREATER COVINA MED GROUP
605 E BADILLO ST
STE 300
COVINA, CA 91723-2847

CPID#4300
GREATER NEWPORT IPA
PO BOX 6270
NEWPORT BEACH, CA 92658-6270

CPID#4300
GREATER SAN GABRIEL VALLE
1680 SOUTH GARFIELD AVE
ALHAMBRA, CA 91801-5413
(626) 282-0288

CPID#1770
GROUP ADMINISTRATORS, LTD
450 E REMINGTON RD
SCHAUMBURG, IL 60173-4540
(847) 519-1880

CPID#4300
AARP CLAIM UNIT
PO BOX BOX 740819
ATLANTA, GA 30374-0819
(800) 523-5800

CPID#4300
AMERICAN PIONEER LIFE
PO BOX 130
PENSACOLA, FL 32591-0130
(800) 999-2224

CPID#6436
AMERICAN POSTAL WORKERS
PO BOX 10398
SCOTTSDALE, AZ 85271-0398
(800) 222-2798

CPID#6467
GOVERNMENT EMPLOYEES HOSP
PO BOX 4665
INDEPENDENCE, MO 64051-4665
(800) 821-6136

CPID#6408
GREAT WEST
1000 GREAT W DR
KENNETT, MO 63857-3749
(800) 445-2158

CPID#6408
GREAT WEST
PO BOX 5011
FORT SCOTT, KS 66701-7111
(800) 685-3040

CPID#6436
AMERICAN POSTAL WORKERS U
PO BOX 3279
SILVER SPRING, MD 20918-3279
(800) 222-2798

CPID#6408
GREAT WEST LIFE AND ANNUI
719 TEACO RD
KENNETT, MO 63857-3741
(888) 377-9378

CPID#6436
AMERICAN POSTAL WORKERS U
PO BOX 1358
GLEN BURNIE, MD 21060-1358
(800) 222-2798

CPID#2895
AMERICAN REPUBLIC INC
PO BOX 10
DES MOINES, IA 50306-0010
(800) 641-0366

CPID#1710
AMERIHEALTH MERCY
PO BOX 7118
LONDON, KY 40742-7118
(800) 521-6007

CPID#2497
ANGELES IPA
711 W COLLEGE ST
688
LOS ANGELES, CA 90012-1163

CPID#4300
ANTHEM HEALTH
PO BOX 873
SACRAMENTO, CA 95812-0873
(800) 888-1801

CPID#4300
APOLLO INSURANCE
4704 W JENNIFER
104
FRESNO, CA 93722-6419

CPID#8456
ARCADIAN MANAGEMENT SERVI
PO BOX 4198
COVINA, CA 91723-0598
(800) 699-5125

CPID#8456
ARCADIAN MANAGEMENT SERVI
PO BOX 4218
COVINA, CA 91723-0618
(866) 424-4748

CPID#4300
ASSOC HISPANIC PHYSICIANS
880 S ATLANTIC BL
201
MONTEREY PARK, CA 91754-4773

CPID#4300
ASSOCIATED STUDENTS INC
PO BOX 24768
LOS ANGELES, CA 90024-0768

CPID#4300
AT&T COMMUNICATION WC
333 S BEAUDRY ST
12TH FL
LOS ANGELES, CA 90017-1466

CPID#1732
ATHENS ADMINISTRATORS AHC
2552 STANWELL ST
PO BOX 696
94520-4851

CPID#4300
AVMA GROUP HEALTH
PO BOX 909720
CHICAGO, IL 60690-9720
(800) 621-6360

CPID#4300
ANTELOPE VALLEY MEDICAL G
44469 N 10TH ST W
LANCASTER, CA 93534-3324
(661) 723-2864

CPID#4300
AXMINSTER MEDICAL GROUP
11539 S HAWTHORNE BL
6 FLOOR
HAWTHORNE, CA 90250-2381

CPID#4300
BANKERS FIDELITY CLAIMS
PO BOX 105652
ATLANTA, GA 30348-5652

CPID#4300
BANKERS LIFE AND CASUALTY
PO BOX 66927
CHICAGO, IL 60666-0927
(312) 777-7000

CPID#4300
GREATER COVINA MED GROUP
605 E BADILLO ST
STE 300
COVINA, CA 91723-2847


CPID#4300
GREATER NEWPORT IPA
PO BOX 6270
NEWPORT BEACH, CA 92658-6270

CPID#4300
GREATER SAN GABRIEL VALLE
1680 SOUTH GARFIELD AVE
ALHAMBRA, CA 91801-5413
(626) 282-0288

CPID#1770
GROUP ADMINISTRATORS, LTD
450 E REMINGTON RD
SCHAUMBURG, IL 60173-4540
(847) 519-1880

CPID#4300
GROUP HEALTH PLAN
PO BOX 7374
LONDON, KY 40742-7374
(800) 755-3901

CPID# 4300
AVMA GROUP HEALTH
PO BOX 909720
CHICAGO, IL 60690-9720
(800) 621-6360

CPID#4300
ANTELOPE VALLEY MEDICAL G
44469 N 10TH ST W
LANCASTER, CA 93534-3324
(661) 723-2864

CPID#4300
AXMINSTER MEDICAL GROUP
11539 S HAWTHORNE BL
6 FLOOR
HAWTHORNE, CA 90250-2381

CPID#4300
BANKERS FIDELITY CLAIMS
PO BOX 105652
ATLANTA, GA 30348-5652

CPID#4300
BANKERS LIFE AND CASUALTY
PO BOX 66927
CHICAGO, IL 60666-0927
(312) 777-7000

CPID#4300
GREATER COVINA MED GROUP
605 E BADILLO ST
STE 300
COVINA, CA 91723-2847

CPID#4300
GREATER NEWPORT IPA
PO BOX 6270
NEWPORT BEACH, CA 92658-6270

CPID#4300
GREATER SAN GABRIEL VALLE
1680 SOUTH GARFIELD AVE
ALHAMBRA, CA 91801-5413
(626) 282-0288

CPID#1770
GROUP ADMINISTRATORS, LTD
450 E REMINGTON RD
SCHAUMBURG, IL 60173-4540
(847) 519-1880

CPID#4300
GROUP HEALTH PLAN
PO BOX 7374
LONDON, KY 40742-7374(800) 755-3901

CPID#6409
GUARDIAN INSURANCE
PO BOX 8007
APPLETON, WI 54912-8007
(800) 873-4542

CPID#4300
GVMG BLUE CROSS COMMERCIA
PO BOX 8019
REDONDO BEACH, CA 90277-8019
(310) 965-1100

CPID#4300
GVPA ATENA COMMERCIAL
PO BOX 6009
TORRANCE, CA 90504-0009
(310) 965-1100

CPID#2202
HARTFORD INSURANCE
PO BOX 9126
DES MOINES, IA 50398-0001
(800) 247-2192

CPID#2742
HARVARD PILGRIM
PO BOX 699183
QUINCY, MA 02269-9183
(800) 742-8326

CPID#4300
BAY AREA PAINTERS
PO BOX 23080
OAKLAND, CA 94623-2308
(866) 894-3705

CPID#4300
HEALTH CARE COST CONTAINM
PO BOX 25520
PHOENIX, AZ 85002-5520
(800) 523-0231

CPID#3206
HEALTH COMP ADMINISTRATOR
PO BOX 45018
FRESNO, CA 93718-5018
(800) 442-7247


CPID#4300
BAY VALLEY MEDICAL GROUP
27212 CALIROGA AVE
HAYWARD, CA 94545-4339
(510) 785-5000

CPID#4300
BEAVER MED GRP
PO BOX 3001
REDLANDS, CA 92373-0307

CPID#4300
HEALTH NET MEDI CAL
PO BOX 14598
LEXINGTON, KY 40512-4598
(800) 675-6110

CPID#3795
BEECH ST
PO BOX 16609
92623-6609
(714) 472-5045

CPID#4300
HEALTH NET SENIORTY PLUS
PO BOX 14703
LEXINGTON, KY 40512-4703
(800) 929-9224

CPID#3795
BEECH ST PPO
PO BOX 23759
COLUMBIA, SC 29224-3759

4300
HEALTH PARTNERS CLAIMS
PO BOX 1289
MINNEAPOLIS, MN 55440-1289
(800) 444-4558

CPID#4300
BELLA VISTA MEDICAL GROUP
PO BOX 572066
TARZANA, CA 91357-2066
(818) 702-0100

CPID#4300
BENEFIS E AND W
1101 TWENTY SIXTH ST S
GREAT FALLS, MT 59405-5161

CPID#4300
BENEFIT PANEL SERVICES
PO BOX 60650
LOS ANGELES, CA 90060-0650
(800) 421-8113

Questions on
Electronic Medical Billing and Claims then click here medical claims electronic billing

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Clearinghouse Electronic Claim issue

I had a client email me a question needing to know how to handle a situation where she is billing claims electronically to RelayHealth which RelayHealth is dropping to paper and mailing to the insurance carrier. The Insurance carrier is notifying the client that the wrong format is being used - how does she fix this.

The carrier CPID#1360 (HCFA-1500 format) is setup incorrectly causing the claim to be billed to the wrong Claim Template which is causing the claim exclusions.

CARE IMPRVMNT PLUS OF TX CPID: 1360PA (should be billed as CPID 4300 CMS-1500 format)

Follow these steps:
1. Log into the office key
2. Click on Master Files > Carriers > Carriers
3. Pull up Insurance Carrier: Care Improvement Plus of TX
4. Change the CPID#1360 (HCFA 1500 format) to 4300 (CMS 1500 format)

Once the carrier has been fixed please rebill all claims

1. Billing > Insurance Billing > Rebill Claims
2. Enter this insurance carrier as high and low
3. Select a date range like current year
4. Click Next

After claims are rebilled re-submit them to McKesson
1. Click on Claims Submission Wizard
2. Enter insurance carrier as high and low
3. Click Next

Call the insurance carrier in about 10-15 business days to verify they are receiving the claims on the correct claim template.

**These steps are based on the AdvancedMD practice management software which is what the client uses. Please follow the steps specific to your PM software to fix and rebill claims.

Interested in
Medical Billing and Coding read more articles on Medical Coding and Billing Courses
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Medi-Cal Modifier Update

As of July 1st 2008 Medi-Cal of California is no longer requiring modifier ZS for radiology and laboratory services that are 100% professional or technical component.

Read the attached document to identify when to use modifier 26, TC or ZS and when not to use them.

ZS modifier: Professional and Technical Component
TC modifier: Technical Component
26 modifier: Professional Component



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Diagnosis Code to use for J0725 when billing to Aetna

I received a email from a client that had a question on a claim inspector edit:
Aetna has a infertility policy CBP # 0327 at the website below that covers J0725 - Injection, chorionic gonadotropin, per 1,000 usp units. The Texas House & Senate passed a bill that covers certain fertility medications & services. Can you review this for me with the AMD Edit # in the screen print I added below. Hopefully, these questions are not off the sleeve to much for you. I am out of my element with the time change and all. Thanks C.M.


http://www.aetna.com/cpb/medical/data/300_399/0327.html

Gonadotropins

  • Human chorionic gonadotropin (hCG) (A.P.L., Novarel, Pregnyl, Profasi HP, Ovidrel, Chorex, Choron)
  • Human menopausal gonadotropin (hMG) (menotropins) (LH and FSH) (Menopur, Repronex)
  • Recombinant follitropin products (recombinant FSH) (Follitropin alfa (Gonal-F); Follitropin beta (Follistim)
  • Urofollitropin (human FSH) (Fertinex, Bravelle).

Gonadotropins are considered medically necessary for the following indications:

  • Women with WHO Group II ovulation disorders such as polycystic ovary syndrome who do not ovulate with clomiphene citrate or tamoxifen. (See appendix for WHO classification of ovulation disorders.)
  • For use in pituitary down-regulation as part of in vitro fertilization treatment (Note: coverage of gonadotropins for this indication is limited to plans that cover advanced reproductive technologies. Please check benefit plan descriptions for details.)
  • Pulsatile administration of gonadotropins are considered medically necessary for women with WHO Group I ovulation disorders (hypothalamic pituitary failure, characterized by hypothalamic amenorrhea or hypogonadotropic hypogonadism)
  • Clomiphene plus gonadotropins may be considered medically necessary in women who do not ovulate using clomiphene alone.

How to resolve this question:


The issue - claim was scrubbed through a claim inspector software (Ingenix) and kicked out for Aetna claim that was billing with a J0725. This was my response to her email:

Your information is extremely well researched. The screen shot shows the J0725 diagnosis code as 629.9 (unspecified disorder of female genital organs). The edits says the diagnosis code associated with the J0725 is not normally associated to this procedure code. The documentation you sent me (thank you again for your thoroughness) does not list 629.9 as being a “covered” diagnosis code.

Ingenix is notifying you that this procedure may be rejected due to a “possible” invalid diagnosis code. It doesn’t mean you will not get a payment but they are warning you of the possibilities. Since you have a listing I would recommend following up with your provider and review this list of DX codes and identify what he/she would like to do.


Ingenix Edit Rule Code: 73065080 None of the ICD-9 CM Diagnosis Codes on this claim line are frequently associated for procedure J0725.

Happy Billing!

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Utah Orthodontist in Sandy Utah

On Sunday evening my Retainer broke. I have had this retainer for over 16 years and I wasn't familiar with any orthodontists in Utah. This meant time looking for a Orthodontist and finding one that will do a great job etc. Over the last 16 years I have had an eye injury, Lock Jaw (TMJ) issues, a car accident, migraine headaches and not to mention that my teeth just normally shift. I not only wanted a new retainer but I wanted an orthodontist to see if I needed braces again to re-align my teeth.

I personally feel grateful that I was lead to Dr. Scott Vincent's team. I won't go into details how I found him but I am just really glad I did. The wonderful staff took my x-rays and pictures and then Dr. Vincent came in and examined my mouth. We talked about my migraine, headaches, tension through my jaw, car accident, eye accident and other details (over 30 minutes) and then he looked at my x-rays. We talked about many different ways of resolving my TMJ and tension issues. We talked about a lot of information during the meeting and I don't want to mis-speak about what was discussed but he said woman around my age bracket do normally have TMJ and Lock jaw issues.

For now I am getting a new Retainer (YEAH) and a bite plate. He recommends that I get a consultation from Jason R Lewis DDS www.jasonrlewis for a follow up on how to alleviate my lock jaw/tension issues but for the first time I felt like the doctor actually listened to me, was concerned about my needs and directed me in the right way.

For patients looking for a great Orthodontist I would highly recommend Dr. Scott G Vincent DMD, MS (www.vincentteamortho). He really is highly skilled and extremely informative with great office manners.

For kids and teenagers you will love him. He has a X-Box, flat screen tv, friendly staff, and beautiful office. He makes the office extremely fun.

Dr. Scott Vincent
1030 East 11400 South Ste B
Sandy UT 84094
801-495-2560

  • Damon System Orthodontics
  • Happy patients

Jason R Lewis
11447 South 700 East Studio A
Draper UT 84020Phone: 801-572-5154

  • One of Utahs top cosmetic dentists
  • Graduate of LVI Aesthetic Institute
  • Advanced Smile Enhancements
  • Full Mouth and Bite Reconstruction
  • Neuromuscular Diagnosis and Orthodontics
  • Laser Dentistry
  • Utah's most advanced Facility
  • Free Aesthetic Consultation


For more course information on Medical Billing check out Online Medical Coding and Billing Courses

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Tuesday, August 26, 2008

Medicare reporting issues

If your clearinghouse is RelayHealth and you billed to any of the following insurance carriers from April 1st - current please be aware that you will receive duplicate Batch Detail Control Listing Report and Provider Summary Reports.

CPID# 2469 Massachusetts Medicare
CPID# 2470 New Hampshire Medicare
CPID# 2470 Vermont Medicare
CPID# 2472 Maine Medicare

Please be mindful of the duplicate reports and archive them as normal.

Learn more about Electronic
Medical Billing and Coding at this site medical billings and health insurance claims

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Memphis Managed Care - TLC claim alert

If you bill to CPID#8574 Memphis Managed Care - TLC all claims submitted to RelayHealth from July 15th - July 29th need to be rebilled and resubmitted electronically.

Their was a bad connection between RelayHealth and Memphis Managed Care resulting in claims not being delivered during this time period.

Happy Billing!

Questions on
Electronic Medical Billing and Claims then click here medical claims electronic billing
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Friday, August 22, 2008

Looking for a Medical Coding Trainer

In the medical industry I am always asked if I know of a good OnlineMedical Coding Program that I endorse. I have done some research and identified not all are made equal. I decided that with the right Master Mind group we could put together a wonderful program.

I am looking for someone who is passionate about the medical industry and has trainning experience on medical coding. Someone who is a big thinker and can work outside of the box an has spare time to work on this project. It is August 22nd 2008 and I am looking to get started quite soon so please don't hesitate.

If you have any experience in Medical Coding and have some time to work on a project with me please contact me through this blog.

Click on the comments and send me a email or phone #. I will not post your comments and keep your information private but will contact you shortly.

To view over 250 articles on
Medical Billing and Coding information please check out Medical Billing and Coding Articles

Medical Billing and Coding Keyword Tags: medical billings and claims, medical billings claims, medical claims electronic billing, claim billing software, electronic medical claim billing, lytec medical billing software, medical billing schools, medical coding and billing schools, medical billing schools online, medical coding and billing schools online, medical billing classes online, online medical billing school, medical billing and coding courses online, courses online, medical billing classes, chiropractic software, online courses medical billing, medical office billing software, medical coding schools, medical coding courses, on line medical billing, medical billing programs, Medicare billing software, medical billing software, medisoft medical billing software, web based medical billing, degree medical billing, electronic medical billing, electronic medical billing software, medical billing education, medical insurance billing software, medical billing and coding course, medical billing online course, medical billing software company, learn medical billing, insurance billing software, Coding training, certified coder training, coding trainer, Certified Coder looking for interesting opportunities

Claim Rejection Edit Issues

If your offices bill with a National Drug Code (NDC) and bill to insurance Carriers Indiana Medicare (CPID#3500), Georgia Medicare (CPID#3536), Iowa Medicare (CPID#2537), Ohio Meidcare (CPID#3507), Kentucky Medicare (CPID#5533), or Illinois Medicare (CPID#5506) you will find a new edit was added on August 22nd 2008 by RelayHealth.

A high volume of claims have been rejecting because Loop 2410 (Drug Identification) LIN Segments sent with one Loop 2400 (Service Line Number) SV2 Segment for multiple CPID#'s.

Edit ID: 0001D: Only 1 LIN can be present in loop 2400 if SV2 present, only 1 2410 LIN can be present.

Fix: Only 1 National Drug Code can be present in the loop 2410 LIN segment

* LIN: Identified the NDC

Happy Collecting!

Questions on Electronic Medical Billing and Claims then click here medical claims electronic billing
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Thursday, August 21, 2008

Mississippi Medicaid requesting you to stop sending secondary claims electronically

If you are billing to Mississippi Medicaid (CPID#1490) they are at this time requesting medical offices to stop submitting secondary claims electronically. If you are billing claims through RelayHealth they have added a new edit to make you aware of this issue:

Edit: 14 0011C Invalid Other Insurance - Loop 2320 Cannot be Present, the payor does not accept COB claims.

Fix: Stop sending Secondary Claims Electronically at this time until the insurance carrier Mississippi Medicaid can handle the transmission.

Happy Collecting

To view over 250 articles on
Medical Billing and Coding information please check out Medical Billing and Coding Articles

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Tuesday, August 19, 2008

Athens Area Health Plan Select has a new edit for electronic claims

If you use RelayHealth clearinghouse and bill to CPID#1732 Athens Area Health Plan Select please be aware of a new edit created on August 19th.

Edit: 18 0005C Missing Qualifier Code - in loop 2300, principal diagnosis code is required for each claim. H101-1 = BK

Fix: Review your procedure codes and identify that each code as a Principal Diagnosis Code. Fix the claim to have a principal diagnosis code and rebill.

Questions on
Electronic Medical Billing and Claims then click here medical claims electronic billing

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Saturday, August 16, 2008

Electronic Claims to North American Medical Management of Illinois

On August 8th 2008 RealyHealth (clearinghouse) notified billers that CPID#5498 North American Medical Management would be terminated however; they were going to try and find other connections for electronic billing.

On August 15th 2008 RelayHealth sent out a notice indicating that we can bill to any of the following insurance carriers instead. None of these insurance carriers require EDI Agreements which means you can bill to them immediately however; if it is unsure which one to send the claims to please call North American Medical Management of Illinois for confirmation.

CPID# Payor Name
4495 Swedish Covenant
4497 Ingalls Provider Group
4731 Northwest Community
4732 Silver Cross
4733 Hinsdale
4734 Elmhurst Memorial
4735 Oak West
4736 Health Options of Illinois

Confused by
Electronic Medical Claim billing then read these articles on Billing Health Insurance medical claims

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Tuesday, August 12, 2008

Electronic Certificate of Medical Necessity

For medical practices that complete Certificates of Medical Necessity forms you can choose these options:

  • Copied form mailed in with paper claim
  • Faxed form
  • Electronic claim transmission - CMN documentation sent electronically with claim.

Contact your Practice Management software or Clearinghouse to identify if they currently support the electronic claim transmission format. Also, be aware that your office should still complete a paper CMN form and keep in the patients chart files with the providers signature or scanned in the patients chart files with your PM software.

If claims are submitted electronically and DMERC feels that something has been falsified or is incorrect they can request a copy of the original signed documentation at any time. Your medical office will be required to supply the paper form at this time for claims payment.

To locate the CMN forms please visit: http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp#TopOfPage and follow these steps:

1. Check mark Show only items containing this word: Certificate

2. Click Show Items

**Everything will pull except for the DME Information Form - External Infusion Pump DME 09.03 (go back to the Show only items and enter DME 09.03 and click Show Items again)

All forms needed:

CMS 484 Certificate of Medical Necessity - Oxygen DME 484.03

CMS 846 Certificate of Medical Necessity - Pneumatic Compression Device DME 04.04B

DME 847 Certificate of Medical Necessity - Osteogenesis Stimulators - DME 04.04C

DME 848 Certificate of Medical Necessity - Transcutaneous Electrical Nerve Stimulator (TENS) - DME 06.03B

CMS 849 Certificate of Medical Necessity - Seat Lift Mechanisms - DME 07.03A

CMS 854 Certificate of Medical Necessity - DME 11.02

CMS 10125 DME Information Form - External Infusion Pumps DME 09.03

CMS - 10252 Instructions for completing the Certificate of Data Destruction for Data aquired from the centers for Medicare & Medicaid Services


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Indiana Medicaid possible electronic claim denials

If you are billing to Indiana Medicaid CPID#1474 and 3501 a new claim exclusion edit has been added to kick out claims with a negative value in Loop 2400 SV102.

The Edit 10 version 0003: In Loop 2400 SV102 cannot contain a negative value.
To Fix: The procedurce code charge can not be a negative value. One of your procedures or your total charge amount is a negative dollar.

Fix and rebill claims.

Confused by
Electronic Medical Claim billing then read these articles on Billing Health Insurance medical claims

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Medical Clearinghouse Reports Simplified

Have you ever been confused over the Clearinghouse Reporting system? Well, let me try and break it down in the most simplified terms:

A few years ago most medical offices were ecstatic about being able to send electronic claims (NO MORE PAPER - YEAH) but now insurance carriers are sending clearinghouses so much more information. Clearinghouses can choose to supply/support different features based on their clients needs. Identify with your Clearinghouse which reports they can supply to you.

Reports:
270 Electronic patient Eligibility Inquiry
271 Electronic patient Eligibility Response (does the patient have insurance)

275 Documentation/Medical Attachment (i.e. Texas Workers Compensation claims)
276 Claim Status Inquiry
277 Claim Status Response (is claim on file, was claim paid, why is claim pending)
278 Prior Authorization and Service Authorization
820 Remittance Advice for Managed Care Organizations
834 Medicaid Enrollment for Managed Care Organizations
835 Remittance Advice (electronic explanation of benefits or EOB)
837P Professional Health Care Claim (CMS-1500 format or HCFA 1500 format)
837I Institutional Health Care Claim (UB04 or UB92 format)
837D Dental Health Care Claim
997 Acknowledgement of Claim Status




What you may not know is that Clearinghouses also supply additional services like:
Patient Address Verification
Patient Credit Verification
Patient Credit History
Patient Ability to Pay
Claim Scrubbing
Statements (ask them how long it takes for the clearinghouse to get the statements to the post office)
Collection Letters

Logos on Statements
Appointment Reminder Postcards
Custom Inserts
Financial Documents
Online Patient Portal
Reporting Options


I have found a wonderful website which reviews many of the clearinghouses for purchase. Please visit:
http://www.medicalbillingsoftwarepro.com/Medical%20Billing%20Clearinghouses.html and click on the links to read more about the services they offer.

Post a comment if you would like me to answer any follow up questions! Or if you have additional questions on Electronic Medical Billing and Claims then click here medical claims electronic billing


Key words: Medical claims clearinghouse, Clearinghouse Reports, patient eligibility reports, electroni patient eligibility response reports, electronic documentation reports, medical billing claim status reports, medical claim status response, prior authorization, claim pending, claim denied, claim exclusion reports, medical billing, medical collections, HCFA, CMS-1500, UB04, Dental Health Claim reports, Acknowledgement reports, exclusion reports, Clearinghouse understanding, learn about clearinghouses, what benefits clearinghouses bring, how to understand clearinghouses benefits, additional services clearinghouses offer, clean claim submission

Monday, August 11, 2008

Humana NPI claim exclusion edits

If your medical office is billing claims electronically to Humana CPID#2449 you will find that starting August 8th, 2008 they are scrubbing for new edits. If you get these edits you are using a invalid NPI or not actually sending the correct NPI information on your claims. Fix and rebill claims.

EDIT HU 0019C:INVALID BILLING PROVIDER NPI - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0020C:INVALID PAY-TO PROVIDER NPI - IN LOOP 2010AB, NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0021C:INVALID CLAIM REFERRING PROV NPI - IN LOOP 2310A, WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0022C:INVALID CLAIM RENDERING PROVIDER NPI - IN LOOP 2010B(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0023C:INVALID CLAIM PURCHASED SERVICE NPI - IN LOOP 2310C(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0024C:INVALID CLAIM SERVICE FACILITY NPI - IN LOOP 2310D(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0025C:INVALID CLAIM SUPERVISING PROVIDER NPI - IN LOOP 2310E(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0028D:INVALID SRV LINE RENDERING PROVIDER NPI - IN LOOP 2420A(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0029D:INVALID SRV LINE PURCHASED SERVICE NPI - IN LOOP 2420B(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0030D:INVALID SRV LINE SERVICE FACILITY NPI - IN LOOP 2420C(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0031D:INVALID SRV LINE SUPERVISING PROVIDER NPI - IN LOOP 2420DC(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0032D:INVALID ORDERING PROVIDER NPI - IN LOOP 2420E(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX EDIT HU 0033D:INVALID SRV LINE REFERRING PROVIDER NPI - IN LOOP 2310C(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

To view over 250 articles on
Medical Billing and Coding information please check out Medical Billing and Coding Articles

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Blue Medicare PPO electronic claim edits

Blue Medicare PPO CPID#4484 through RelayHealth is getting a high number of electronic medical claims due to issues with NPI. These are new edits that were added on August 8th 2008 by RelayHealth:

EDIT HU 0019C:INVALID BILLING PROVIDER NPI - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0020C:INVALID PAY-TO PROVIDER NPI - IN LOOP 2010AB, NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0021C:INVALID CLAIM REFERRING PROV NPI - IN LOOP 2310A, WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0022C:INVALID CLAIM RENDERING PROVIDER NPI - IN LOOP 2010B(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0023C:INVALID CLAIM PURCHASED SERVICE NPI - IN LOOP 2310C(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0024C:INVALID CLAIM SERVICE FACILITY NPI - IN LOOP 2310D(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0025C:INVALID CLAIM SUPERVISING PROVIDER NPI - IN LOOP 2310E(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0028D:INVALID SRV LINE RENDERING PROVIDER NPI - IN LOOP 2420A(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0029D:INVALID SRV LINE PURCHASED SERVICE NPI - IN LOOP 2420B(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0030D:INVALID SRV LINE SERVICE FACILITY NPI - IN LOOP 2420C(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0031D:INVALID SRV LINE SUPERVISING PROVIDER NPI - IN LOOP 2420DC(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0032D:INVALID ORDERING PROVIDER NPI - IN LOOP 2420E(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0033D:INVALID SRV LINE REFERRING PROVIDER NPI - IN LOOP 2310C(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

For more articles about
Medical Billing and Coding read this Over 250 Medical Billing and Coding Articles

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Community Health Plan of Washington CHPWA electronic claim edits

If you are currently billing electronic medical claims to CPID#3445 Community Health Plan of Washington (CHPWA) you may have had medical claims getting rejected for NPI issues. On August 7th 2008 RelayHealth added these new edits to catch any issues:

EDIT HU 0019C:INVALID BILLING PROVIDER NPI - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0020C:INVALID PAY-TO PROVIDER NPI - IN LOOP 2010AB, NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0021C:INVALID CLAIM REFERRING PROV NPI - IN LOOP 2310A, WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0022C:INVALID CLAIM RENDERING PROVIDER NPI - IN LOOP 2010B(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0023C:INVALID CLAIM PURCHASED SERVICE NPI - IN LOOP 2310C(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0024C:INVALID CLAIM SERVICE FACILITY NPI - IN LOOP 2310D(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0025C:INVALID CLAIM SUPERVISING PROVIDER NPI - IN LOOP 2310E(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0028D:INVALID SRV LINE RENDERING PROVIDER NPI - IN LOOP 2420A(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0029D:INVALID SRV LINE PURCHASED SERVICE NPI - IN LOOP 2420B(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0030D:INVALID SRV LINE SERVICE FACILITY NPI - IN LOOP 2420C(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0031D:INVALID SRV LINE SUPERVISING PROVIDER NPI - IN LOOP 2420DC(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0032D:INVALID ORDERING PROVIDER NPI - IN LOOP 2420E(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0033D:INVALID SRV LINE REFERRING PROVIDER NPI - IN LOOP 2310C(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX


Learn more about Electronic Medical Billing and Coding at this site medical billings and health insurance claims

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Friday, August 8, 2008

Northern and Sourthern California changing to PalmettoGBA on September 2 2008

As of August 27th 2008 RelayHealth will no longer be submitting claims for CPID#1436 & 1444 to intermediary NHIC. They will hold the claims until September 2nd 2008 and at that time transmit the electronic claims to PalmettoGBA. If your office has not completed a EDI Agreement to transmit claims electronically to PalmettoGBA your claims will be excluded.

All EDI agreements getting completed at this time with PalmettoGBA will have a open status for September 2nd 2008 so you will not have any claim transmission issues submitting to NHIC at this time.


If your office transmits claims to Northern and Southern California CPID#1436 & 1444 do not walk, run to RelayHealth's website and complete these EDI agreement forms immediately. Failure to do so could cause claim rejections.

Update: 9/19/08 - Northern & Southern California Medicare through Palmetto GBA has had issues in the delivery of ERA's for check dates 9/2/08 to current. They have identified the issue and are currently working to resolve this. Soon your ERA's should be fine - this is normal for updates with software.

Update: September 24th 2008 -
Northern California and Southern California Medicare are having issues processing re-enrollments of EDI Agreements and are UNABLE to identify which agreements have even been received. I want to point out to everyone I had initially wrote on August 8th to RUN and complete EDI agreements to prevent this issue from happening. Hopefully my clients are not one of those pending for EDI Agreements with these carriers!

Key Words: RelayHealth, Clearinghouse, EDI Agreements, Northern and Southern California Medicare, CPID# 1436 and 1444, Palmetto GBA, Clean Claims, how to bill, medicare billing, claim submission, electronic claim filing, how to get paid, Medical Billing, Medical Coding Billing, Medical Billing Software, Medical coding and billing, home medical billing, online medical billing, medical billing training, medical billing from home, medical billing insurance, medical billing services, medical billing school, medical billing schools, medical billing work, electronic medical billing, Medical Claims Billing, Medical billing & coding, medical billing code, Medical claim billing, Medical insurance billing and coding, medical billing information

NPI claim rejectsion for Memorial Hermann insurance

If you are billing electronic medical claims to CPID#3475 Memorial Hermann you may have identified claims are getting rejected for NPI numbers. As of August 7th RelayHealth added new edits to prevent claims going to Memorial Hermann without NPI. Please fix and rebill any claims that come over with these exclusion edits:


EDIT HU 0019C:INVALID BILLING PROVIDER NPI - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0020C:INVALID PAY-TO PROVIDER NPI - IN LOOP 2010AB, NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0021C:INVALID CLAIM REFERRING PROV NPI - IN LOOP 2310A, WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0022C:INVALID CLAIM RENDERING PROVIDER NPI - IN LOOP 2010B(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0023C:INVALID CLAIM PURCHASED SERVICE NPI - IN LOOP 2310C(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0024C:INVALID CLAIM SERVICE FACILITY NPI - IN LOOP 2310D(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0025C:INVALID CLAIM SUPERVISING PROVIDER NPI - IN LOOP 2310E(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0028D:INVALID SRV LINE RENDERING PROVIDER NPI - IN LOOP 2420A(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0029D:INVALID SRV LINE PURCHASED SERVICE NPI - IN LOOP 2420B(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0030D:INVALID SRV LINE SERVICE FACILITY NPI - IN LOOP 2420C(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0031D:INVALID SRV LINE SUPERVISING PROVIDER NPI - IN LOOP 2420DC(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0032D:INVALID ORDERING PROVIDER NPI - IN LOOP 2420E(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0033D:INVALID SRV LINE REFERRING PROVIDER NPI - IN LOOP 2310C(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

Happy Collecting!

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Clearinghouse that receive Online Claim Status 276/277 reports

A medical billing service with over 150 providers / 80 data bases asked me one day on my thoughts of creating a medical software that would search medical insurance carriers websites for medical claim status. I explained to him that last year I had the same thoughts when I was frustrated checking online claim status for so many patients. I thought if I had a software system that could go out, log in to these medical insurance carriers websites and check for me it would save me 100's of hours.

Well, that got me to thinking that their has to be a better way and I also figured someone else must surely have already created it. So I searched high and low until I found this website: Practice Management Software Reviews and I was searching through the navigational bar and found a link for Medical Clearinghouse Reviews. I began clicking on the links to read more about the clearinghouses when I read that these clearinghouses could check claim status for those claims you submitted electronically through them. I was in awe!

So, I asked the VP of the billing service what clearinghouse he uses and he said RelayHealth. I told him he was in luck! His clearinghouse does receive the 276/277 reports . He mentioned that his practice management software is interfaced with RelayHealth so I told him to follow up with his PM and ask them to create a interface to receive the claim status reports from RelayHealth. He was excited knowing this was an option that he can present to his software vendor!

How Does this help for big or small medical practices -
Picture this - the client bills out over 16,000 claims a month. Of those 16,000 claims lets assume that all are being submitted electronically. He has claim scrubber and other tools that assists him in sending 95% of his claims clean resulting in a average of 5% denials or 800 denials a month. What if he had a tool that could search for those 800 claims within minutes and notify his billing office the status of the claim i.e.


  • claim pending
  • claim denied for XYZ
  • claim paid with check #, $ amount and mailed to
  • claim not on file
  • claim processed on XX/XX/20xx and check is coming
Within minutes his billers know what is expected and can promptly work those denials without having to first call for the status of ALL claims. Just think how this can change your business dynamics!

Clearinghouses that I was able to find
that accepted the 276/277 reports.

Expect more /get more!

ANS Affiliated Network Services
Instantly Track and report on claims status

Availity ThinEDI software
Manage accounts receivable by checking claim status for processed claims

Electronicclaim.net
Get check numbers and check dates on paid electronic claims
Detailed status of each outstanding electronic claim
Uses
837Direct to generate electronic Status Requests
Easy to use Wizard to generate 276 electronic claim Status Requests
837 electronic claim Batch Transmissions can be confirmed
Inquire on the Status of any outstanding electronic claims
Inquire on the status of multiple electronic claim batches

Emdeon
With Emdeon Vision, payers have the ability to perform claim searches, verify claim status and generate a variety of claim trending and summary reports

ENS Electronic Networking Systems
ECT allows you to quickly search any claims you have sent and ensure they were properly received by the insurance payer within seconds.
Greatly reduce follow-up time and phone work tracking unpaid claims
Track all claims online using quick or advanced search options
Easily print or view the results on your screen
Real-time response, accessed via the Internet

Gateway EDI Clearinghouse
Unlimited Individual Claims Status Inquiry

InstaMed clearinghouse
Get answers to your claim submissions in seconds, including claim acceptance, pre-adjudication results on eligibility, clinical coding verifications, and WEDI levels 1-7 claim edits.

Medavant
To find your claim's status at the payer, run a Claim Status Inquiry (CSI) for real-time information at every stage of the adjudication process.

Medx12
The MedX12 Claim Status Inquiry feature allows physicians and other healthcare providers to easily access up-to-date information on previously filed claims. By providing you with the most current status received from payers, we help you manage your accounts receivable and reduce the costs incurred in contacting the payer for an updated status.

Navinet
easily and efficiently submit, track, check the status of claims, and reconcile reports, electronically.

PayerPath
efficiently submit online, real-time inquiries to payers about the status of a transmitted health insurance claim. Even better, you'll reduce the amount of time spent manually checking a health insurance claim status while at the same time improve record keeping.

RelayHealth
RelayHealth’s website does not specify all of the reports they support however; they do offer them

ZirMed
Our Claims Tracking feature allows you to follow the progress of the claim every step of the way


For more information on how to Read EDI Reports:
How to read EDI clearinghouse reports
Clearinghouse EDI Reports
Clearinghouse Online Claim Status EDI Reports


Tags: Clearinghouse, Clearinghouse Reports, Who offers 276/277 Clearinghouse Reports, Claim Status clearinghouse reports, medical billing, medical insurance, claims filing, online claim status, electronic claim status review, understanding the status of your medical claims in a timely filing fashion, Medical claims processing, collections, billing, insurance, carriers, insurance carriers claims status, checking insurance carriers and the status of outstanding claims, filing of insurance carriers, knowing the accounts receivable, aging, medical collections, medical insurance claim filing, secure claims status check, private, free, tips, tricks, suggestions for saving time in the medical office, hospitals, employers, physicians, doctors, medical offices, hospitals, understanding EDI reports, clearinghouse review, what clearinghouses can offer, understanding insurance claims and reports

Online Eligibility documentation

If you have a practice management software that is integrated with checking Online Eligibility you will be able to receive the following information:

1. Confirmation that the insurance carrier recognizes this patient

  • This means the patients Subscriber ID# was setup correctly
  • This means the patients demographics and subscriber demographics are setup correctly resulting in a cleaner claim submission knowing the information was added correctly.

2. Identify the copayment, coinsurance, deductibles and possible knowledge whether the service you are about to render will be covered.

3. If the patient needs to contact the insurance carrier. At times documentations are required and from the Subscriber and some carriers will submit this information.

For information on cheap ways to check patient eligibility please visit this website: Methods for Checking Patient Eligibility


Confused by Electronic Medical Claim billing then read these articles on Billing Health Insurance medical claims

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EDIT 21 0403:INVALID RENDERING PROVIDER NUMBER - IN LOOP 2310B, IF REF01 = 1D, REF02 MUST BE 5 OR 8 ALPHANUMERICS

If you are billing to CPID#1492 New Mexico Medicaid you may have noticed a rejection Loop 2310B Ref Segment - invalid rendering provider number. New Mexico Medicaid is stating that if a Legacy Medicaid Provider number is being sent in Loop 2310B with a Ref 1D qualifier, the Ref02 value must be a valid New Mexico Medicaid Rendering Provider #.

RelayHealth has added this new Edit so that you can be aware of this issue:
EDIT 21 0403:INVALID RENDERING PROVIDER NUMBER - IN LOOP 2310B, IF REF01 = 1D, REF02 MUST BE 5 OR 8 ALPHANUMERICS
This means you must be submitting the correct legacy provider number formats.

Confused by
Electronic Medical Claim billing then read these articles on Billing Health Insurance medical claims

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Cheapest methods for checking patient Eligibility

I am going to talk about a busy 3 doctor pediatrician office to explain why eligibility is extremely important. I was able to clean up the practice from about 80% in clean claim submission to about 95% clean claim submission under 45 days. With this part knocked out the biggest issue I was finding is that new born babies were my 3% of claim denials for not being eligible.

This practice has a strict policy that all patients are self-pay until the baby is added to the insurance plan however; the front office had not been checking eligibility for any of the patients and just taking the insurance card. The reason for not checking eligibilty - TIME.

So I reviewed what it would cost to check eligibility:

Practice Management Software Eligibilty search through RelayHealth: Our PM software charges $250.00 setup for the practice and $.45 cents an inquiry $39.00 a month per provider for unlimited eligibility status. Not all patient searches come back with documentation and those still need a phone call or website search but over all it is quick and efficient. It is not the cheapest eligibility search on the market (I have seen some that charge more like $.20 - $.35 cents a inquiry) but it works.
$117.00 a month ($39*3) for unlimited eligibility

Phone: This practice does not treat Medicare or Medicaid patients so that was a plus. We figured it would take about 30 minutes an inquiry and at 35 patients a day that would take 1050 minutes or 17.5 hours (over 2 man hours to check eligibility). This of course was not a option but we know that the success rate of calling insurance carriers are extremely high at getting the correct information the first time around.

Fax: Fairly inexpensive however; we need to complete it well in advance and not all insurance carriers accept Fax. We figure it takes 10-15 minutes per patient. 35 patients a day and maybe of these only 10 of their insurance carriers will accept faxing.

Online Eligibility through insurance carriers website: Quick, efficient and extremely accurate. I really like this method however; it does still take time but it can be done in the evenings and early mornings. If you have a internet savvy employee they can quickly get through 35 patients in 7-8 hours. 35 patients x 10 minutes /60 min in a hour.

IVR (interactive voice response): Phone calls to insurance carriers that have eligibility IVR are another good reliable source for eligibility. Of course you need to call during the operational IVR hours and sometimes you will get through all of the prompts just to find out that the system is down. 5-15 minutes a phone call per patient.

Insurance Card Swipe: Some insurance carriers like United Health Care have a swipe on the back of their insurance card that you can run through your credit card machine. Be aware that their are credit card fees which vary per contract and sometimes the information you recive is not extremely helpful.

Have the Patient Complete it: some offices require the patients to complete their own eligibility check. This doesn't cost the office anything unless you get a angry patient who decides to go to another practice because of the inconvenience this causes them.

We went with the online eligibility search through the practice management software and that has helped a lot. My claim exclusions for non-eligibilty has gone down and the front office feels like they still have time to complete their other office duties. Of course when they get behind I don't mind checking a handful through the online website option and notifying them of what I have found. The point is that we are now at 98% clean claims submission and the doctors have never been so happy!

My recommendations is to do a little bit of all of them since Eligibility is an important part of collections. In a busy medical practice you have to give people options to completing them while also identifying the Financial Aspect to the options. Let me know if this helped you at all.

If you are looking for
Practice Management Software vendors that have online eligibility you can visit http://www.medicalbillingsoftwarepro.com/ and scroll down the navigational bar until you get to the Web-based Medical Billing Reviews or the Server Medical Billing Reviews. Click on these links and search away.

Interested in additional
Online Medical Billing and Coding articles? Then click out Billing and Coding Online Courses

Medical Billing and Coding Keyword Tags: medical billings and claims, medical billings claims, medical claims electronic billing, claim billing software, electronic medical claim billing, lytec medical billing software, medical billing schools, medical coding and billing schools, medical billing schools online, medical coding and billing schools online, medical billing classes online, online medical billing school, medical billing and coding courses online, courses online,